Better Sooner More Convenient Primary Care - New Zealand Doctor

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It's trustees are derived from three sectors as follows: community, Māori and providers (three from each): three community trustees are appointed from each of the three District Councils two Māori trustees are appointed from each of the two runanga one Māori trustee is elected - by the Māori health providers electoral college three provider trustees are elected - each of the general practitioner, practice nurse and practice administration staff electoral colleges elect one trustee. The PHO provides some health services itself, but also subsidises patient care through its substantial funding for the eight medical centres across the Coast. Five of these practices are owned by the DHB, two by health professionals, and one by the PHO itself. The PHO's statement of strategy and priorities is: The purpose of the PHO is to promote and enable better health for the population on the West Coast and actively work to reduce health inequalities amongst at-risk and disadvantaged groups. The PHO will strengthen and grow its organisational functions as funder, service provider, and service co-ordinator within primary care, as a means to achieving this end and in alignment with the Government‟s Primary Health Care Strategy (PHCS). STRATEGIC OBJECTIVES ARE TO Work with local communities and enrolled populations Identify and remove health inequalities Offer access to comprehensive services to improve, maintain, and restore people‟s health Co-ordinate care across service areas Develop the primary care workforce Continuously improve quality using good information and evidence WE WILL FOCUS ON Improving the management of patients with chronic care conditions Closing gaps of inequality for Māori Improving access to mental health services, including for young people Improving quality of life, eg. by cancer support Improving immunisation rates Enhancing disease prevention programmes Improving the co-ordination of services both within and across services BY USING KEY MECHANISMS AND ENABLERS SUCH AS Better engagement with the community, families/whanau and individuals Improved collaboration at strategic and planning levels with the DHB and Community & Public Health Greater integration with other organisations and NGOs Supporting GP practice teams Supporting individuals and whanau Enhanced health promotion Adoption of efficient business/service models Most of the West Coast's resident population is enrolled in the PHO's eight practices. The distribution in the recent Oct-Dec 09 quarter was as follows: Business case EoI V38 AC 25Feb10 Page 18
Māori/Pacific Not Māori/Pacific Dep 5 Not Dep 5 Dep 5 Not Dep 5 Total Karamea 0 36 17 520 573 Buller Medical Services 192 408 1,790 4,801 7,191 Greymouth Family Health 11 76 147 990 1,224 Greymouth Medical Centre 107 403 703 4,848 6,061 High St Medical Centre 67 288 656 5,214 6,225 Reefton Medical Centre 35 154 206 1,576 1,971 South Westland Area Practice 0 139 0 1,425 1,564 Westland Medical Centre 122 772 505 4,178 5,577 Total 534 2,276 4,024 23,552 30,386 1.8% 7.5% 13.2% 77.5% 100.0% The PHO's net equity as at Dec 09 was $1.1m and its recent operating financial performance is as follows: Revenue Financial performance Jul – Dec 09 First level services & practice VLCA 2,387,473 Administration 197,072 Health Promotion 100,516 Services to Improve Access 115,223 Long Term Conditions 344,159 Other clinical services 31,201 PHO Performance Programme 166,186 Rural Premiums & Reasonable Rostering 769,001 Professional & practice development 35,884 Mental Health & MSD 228,878 Cancer Services 146,370 GP Liaison 40,000 HEHA (breastfeeding support) 43,872 LTC Collaborative Funding 37,139 Expenditure First level services & practice VLCA 2,387,473 Administration 341,157 Health Promotion 83,643 Services to Improve Access 92,159 Long Term Conditions 200,873 Other clinical services 12,936 PHO Performance Programme 87,193 Rural Premiums & Reasonable Rostering 742,784 Professional & practice development 16,281 Mental Health & MSD 198,638 Cancer Services 124,539 GP Liaison 24,819 HEHA (breastfeeding support) 38,766 LTC Collaborative Funding 32,139 4,642,974 4,383,400 Surplus 259,574 Business case EoI V38 AC 25Feb10 Page 19
Page 1 and 2: Business Case Better, Sooner, More
Page 3 and 4: 1 Caveats/status This business case
Page 5 and 6: Current situation By three years Wa
Page 7 and 8: staffed on a capacity model - in wh
Page 9 and 10: support from DHBs, specialist clini
Page 11 and 12: 10.4 Key milestones................
Page 13 and 14: Annual government health funding pe
Page 15 and 16: Ambulatory Sensitive Hospitalisatio
Page 17: The base populations of the three d
Page 21 and 22: 4.7 West Coast region service deliv
Page 23 and 24: 5 Future model of care 5.1 The desi
Page 25 and 26: support them. Help with understandi
Page 27 and 28: LEVERS VISION Better, sooner, more
Page 29 and 30: providing the majority of care). Th
Page 31 and 32: The Community Health System Deliver
Page 33 and 34: To better integrate the support pro
Page 35 and 36: 5.5 Enablers A key aspect of this b
Page 37 and 38: Two rounds of meetings with front l
Page 39 and 40: While doctor-nurse substitution has
Page 41 and 42: Nick Goodwin, Kings Fund 14 , in hi
Page 43 and 44: Quality domains Each new initiative
Page 45 and 46: Preventative Acute LTC management R
Page 47 and 48: Preventative Acute LTC management R
Page 49 and 50: The core services are provided or p
Page 51 and 52: Total required FTEs for the Grey IF
Page 53 and 54: 7 Governance, Ownership & Managemen
Page 55 and 56: Option D: PHO/DHB jointly owned Pri
Page 57 and 58: The IFHS will need the ability to b
Page 59 and 60: Of note, a large proportion of the
Page 61 and 62: The DHB delegates decision making o
Page 63 and 64: Limited integration of community se
Page 65 and 66: 10.4 Key milestones The table below
Page 67 and 68: Expanded pharmacy roles Improving a
Page 69 and 70:
Devolved community based services w
Page 71 and 72:
Appendices Appendix One: Health Equ
Page 73 and 74:
ongoing GP shortage creating an env
Page 75 and 76:
10. What are the unintended consequ
Page 77 and 78:
It is common for people with an acu
Page 79 and 80:
Outcome measures Indicator Baseline
Page 81 and 82:
determine ratio of nurses and GPs t
Page 83 and 84:
C. Extended role for pharmacists:
Page 85 and 86:
11 Engagement Working group who dev
Page 87 and 88:
Appendix B: Acutely unwell adult pa
Page 89 and 90:
4 Objectives to implement nur
Page 91 and 92:
Review Buller after hours arrangeme
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Year three Community education camp
Page 95 and 96:
13 Costs Budget considerations:
Page 97 and 98:
established. This group now oversee
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Output measures Tobacco control / s
Page 101 and 102:
Improving immunisation coverage - h
Page 103 and 104:
Year three Continued joint plan
Page 105 and 106:
extending health promotion activiti
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Immunisation Coverage Funder Provid
Page 109 and 110:
The Community Health System Deliver
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Clinical care Practice self managem
Page 113 and 114:
and increases in the numbers of pat
Page 115 and 116:
Ambulatory Sensitive Hospitalisatio
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% CVD on lipid lowering drugs, beta
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Health navigators/ kaiawhina: chan
Page 121 and 122:
Committee‟s objectives 41 of prov
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- lack of consistency of care betwe
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qualifications and skills. Where ca
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6 Deliverables / activities Impleme
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“With an aging population and an
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Differences between revenue generat
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Appendix Seven: Integration - Healt
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It is expected that HealthPathways
Page 137 and 138:
Year two implement the process to
Page 139 and 140:
Low uptake by primary and secondary
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Appendix Eight: Improved access to
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to easily access by telephone). Oth
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Year One - July 2010 to June 2011 T
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LECG 50 evaluated whether “the im
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Appendix Nine: Referred services 1.
Page 151 and 152:
them by technical errors or lack of
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Identify patients that would benefi
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• Provision of patient specific m
Page 157 and 158:
12 Organisational accountabilities
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emain under the care and management
Page 161 and 162:
Service user pathways in an optimal
Page 163 and 164:
Model for shared care pathways deve
Page 165 and 166:
Implementation plan: to June 30 Dev
Page 167 and 168:
Year two Review progress, outcome m
Page 169 and 170:
10 Risk analysis Risk Probability I
Page 171 and 172:
Appendix Eleven: Frail older people
Page 173 and 174:
ehab and treatment programmes that
Page 175 and 176:
Year one: Maintain and continue the
Page 177 and 178:
Māori have a higher incidence of m
Page 179 and 180:
11 Organisational accountabilities
Page 181 and 182:
There are often vacancies for allie
Page 183 and 184:
6 Deliverables / activities Program
Page 185 and 186:
Professional development: Provide
Page 187 and 188:
Mainstream arguments are concerned
Page 189 and 190:
Appendix Thirteen: IFHCs - Faciliti
Page 191 and 192:
A key possibility is that land at t
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This option is effectively a Greenf
Page 195 and 196:
7 Westland IFHC Facilities options
Page 197 and 198:
Year two Substantive-IFHC in Greymo
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12 Costs Capital costs Greymouth IF
Page 201 and 202:
utilize MedTech, but via their own
Page 203 and 204:
4 Objectives: To implement c
Page 205 and 206:
Security An individual‟s health i
Page 207 and 208:
8 Effect on inequalities The increa
Page 209:
Appendix Fifteen: Project advisory
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